Objective: Bile duct tumor thrombosis in hepatocellular carcinoma (HCC) is a relatively rare event with a poor prognosis. Furthermore, bile duct tumor thrombus in HCC may be misdiagnosed when only imaging modalities are used. The efficiency of peroral cholangioscopy (POCS) in evaluating bile duct lesions has been reported.Patients: We present three cases of HCC with bile duct strictures in which POCS was performed as a preoperative evaluation.Results: In these three cases, diagnosing whether the lesion was a bile duct tumor thrombus on CT and endoscopic retrograde cholangiopancreatography was difficult. We performed POCS in three cases and were able to diagnose the presence of bile duct tumor thrombus of HCC, including differentiation from extrinsic compression of the bile duct.Conclusion: POCS for HCC with bile duct features is useful for the preoperative diagnosis of bile duct tumor thrombus, especially in cases where the surgical procedure depends on the presence of bile duct tumor thrombus.

Sixteen cases of malignant soft tissue sarcoma (STS; 10 canines and six felines) were treated with a novel triple therapy that combined photodynamic therapy, hyperthermia using indocyanine green with a broadband light source, and local chemotherapy after surgical tumor resection. This triple therapy was called photodynamic hyperthermal chemotherapy (PHCT). In all cases, the surgical margin was insufficient. In one feline case, PHCT was performed without surgical resection. PHCT was performed over an interval of 1 to 2 weeks and was repeated three to 21 times. No severe side effects, including severe skin burns, necrosis, or skin suture rupture, were observed in any of the animals. No disease recurrence was observed in seven out of 10 (70.0%) dogs and three out of six (50.0%) cats over the follow-up periods ranging from 238 to 1901 days. These results suggest that PHCT decreases the risk of STS recurrence. PHCT should therefore be considered an adjuvant therapy for treating companion animals with STS in veterinary medicine.
Animals ; Antineoplastic Agents/*therapeutic use ; Cat Diseases/drug therapy/surgery/*therapy ; Cats ; Combined Modality Therapy/veterinary ; Dog Diseases/drug therapy/surgery/*therapy ; Dogs ; Hyperthermia, Induced/veterinary ; Indocyanine Green/*therapeutic use ; Photochemotherapy/veterinary ; Photosensitizing Agents/*therapeutic use ; Sarcoma/drug therapy/surgery/therapy/*veterinary

We measured oxidative stress and antioxidative stress in clinical cases of cardiac and aortic surgery, especially in extracorporeal circulation cases. From June to October 2007, 18 cases who underwent cardiac and aortic surgery with extracorporeal circulation (ECC group) and 8 cases with an infra-renal abdominal aortic aneurysm (AAA group) were studied. We measured reactive oxygen metabolites (d-ROM) in oxidative stress for the operative time, after the operation endpoint, and at one day postoperatively, one, two, and three weeks postoperatively, and one, two, three, and four months postoperatively. Regarding d-ROM, the level in the ECC group was significantly higher than that in the AAA group (p<0.0001). Peak values were observed 3 weeks postoperatively in the ECC group and 2 weeks postoperatively in the AAA group. Although the oxidative stress increased in both groups, the peak value in the ECC group was more marked than that in the AAA group. We concluded that oxidative stress under surgical stress in cardiovascular surgery with extracorporeal circulation was higher than that under surgical stress in cardiovascular surgery for infra-renal abdominal aortic aneurysms.

We report 3 cases of ascending aorta-abdominal aorta bypass for atypical coarctation with Takayasu's aortitis. We performed an extra-anatomical bypass from the ascending aorta to the terminal abdominal aorta. The graft was arranged to pass through the diaphragm from the pericardium, behind the left lobe of the liver and the stomach, to the front side of the pancreas to the terminal abdominal aorta. Although the graft was exposed in the abdominal cavity in part behind the stomach, it was completely covered with the great omentum thus avoiding direct contact between the graft the abdominal organs. Decrease in the pressure gradient between the ascending aorta and the abdominal aorta was achieved using a large prosthetic graft 14-16 mm in diameter. There are several advantages with this technique. (1) Positional change during surgery can be avoided. (2) Anastomosis can be performed in non-diseased vessels. (3) This bypass graft can be branched off to visceral arteries if necessary. Reduction of the after load on the left ventricle and long-term graft patency by using a large diameter prosthetic graft were anticipated. The postoperative courses of all cases were satisfactory. Case 1 died of another disease 11 years and 11 months postoperatively, but the graft to was still patent.

Objectives: This study aimed to determine the activity groupings reflecting functional characteristics required in daily life for the institutionalized dependent females in the old-old elderly group, by examining the interrelationships of activities based on actual achievement characteristics. Methods: The participants were 697 dependent elderly living at welfare institutions in Japan and 344 old-old females were used for analysis. Factor analysis, based on Promax with the Kaiser Normalization method, was conducted using 74 activities of daily living (ADL) items to determine activity groups. Furthermore, whether each activity group could be classified into sub-groups was confirmed by applying factor analysis to the activities consisting of each activity group. Results: Four activity groups of lower extremity activities, manual activities, changing and holding posture activities, and upper extremity and dexterous manual activities were interpreted. Except for the manual activity group, these activity groups were classified into two sub-groups. Conclusions: These activity groupings were characterized by similarities of the body parts used in achievement and the difficulty of activity. The activity groupings obtained in this study are considered to be useful in ADL assessment focusing on evaluating functional characteristics of the dependent elderly.
Elderly ; Old episode ; Manuals ; livin ; g <3>

OBJECTIVESThis study aimed to determine the activity groupings reflecting functional characteristics required in daily life for the institutionalized dependent females in the old-old elderly group, by examining the interrelationships of activities based on actual achievement characteristics.

METHODSThe participants were 697 dependent elderly living at welfare institutions in Japan and 344 old-old females were used for analysis. Factor analysis, based on Promax with the Kaiser Normalization method, was conducted using 74 activities of daily living (ADL) items to determine activity groups. Furthermore, whether each activity group could be classified into sub-groups was confirmed by applying factor analysis to the activities consisting of each activity group.

RESULTSFour activity groups of lower extremity activities, manual activities, changing and holding posture activities, and upper extremity and dexterous manual activities were interpreted. Except for the manual activity group, these activity groups were classified into two sub-groups.

CONCLUSIONSThese activity groupings were characterized by similarities of the body parts used in achievement and the difficulty of activity. The activity groupings obtained in this study are considered to be useful in ADL assessment focusing on evaluating functional characteristics of the dependent elderly.

The aim of this study was to clarify the relationship between physical fitness elements in healthy older adults, considering the differences between gender and between age. Subjects were 1042 active and non-injured people aged from 60 years to under 90 years. The subjects were classified into two different age groups of under 75 years group and 75 years and over group. A total of 11 variables representing four physical fitness elements (muscular, joint, neural, and respiratory functions) were selected through examination of safety and validity. Two-way ANOVA was used to examine gender and age differences in each physical fitness element. Pearson's correlation coefficient and partial correlation coefficient excluding age factor were calculated for each gender and age group.
As a result of examining the relationship among physical fitness elements, the correlation coefficients within variables consisting of the following each function, muscular function, joint function and agility of extremities, were significant in both age groups, and these tendencies were consistent in both gender groups. Similarly, significant correlation coefficients between standing-reach and muscular function variables, and between trunk twist and foot balance with eyes open and reaction time were found in the under 75 years group, but not in the over 75 years group. On the other hand, different tendencies between genders were found in the relationship between the muscular function variables and trunk twist and foot balance with eyes open, and between the reaction time and stepping and muscular function variables. As the relationships among physical fitness elements tended to decline in the over 75 years group, it is inferred that this tendency is influenced by the change with aging of physical fitness characteristics and environmental factors around the older adults.

The purpose of this study was to clarify the application range and utility of an ADL index for disabled elderly people (Demura et al., 2000), by examining the ADL characteristics of an elderly population when this index was applied to disabled and independent elderly people. Subjects of this study were 697 Japanese institutionalized disabled elderly people and 482 independent elderly people (ID) living at home. Disabled elderly people were classified into four groups based on conditions of use of assisting devices for movement; D1 did not use assisting devices; D2 used a stick or a walker; D3 used a wheelchair; D4 was immobile. From the findings of comparing achievement proportions, ADL score and the distribution of total score among elderly groups, it was suggested that this ADL index can assess gradually from disabled elderly people who cannot move to independent elderly people. Since this index classifies independent elderly people and disabled elderly people with high probability, it can evaluate if elderly people can maintain a functional level needed for independent living, and can recognize the symptoms of disability. Furthermore, this study proposed useful activities to discriminate the functional level for each elderly group. Although it is important to comprehensively assess ADL ability, further use of this ADL index to discriminate the functional level of an elderly population, by making use of these useful activities, is expected.
Elderly ; Activities of Daily Living ; Disabled Persons ; Persons ; livin

The purpose of this study was to propose useful ADLs (activities of daily living) and scales to estimate ADL ability on community older people from the viewpoints of aging, physical fitness level, and interrelationship among ADL. The survey constructing of 15 ADL items and physical fitness test of Ministry of Education, Science and Culture were carried out on 458 older people. Each ADL item was constructed with 3 level scales.
As the results of this study, the following 12 ADLs were proposed as useful ADL items; in the locomotion domain, jumping across a ditch, walking, running, up and down stairs, and transfer; in the manipulation domain, taking bedding in and out, buttoning a shirt; in stability domain, standing in the bus or train, dressing while standing (trousers), standing on one foot with eyes open; in the posture-change domain, sitting up, standing up from the floor. These items were significantly related to age and physical fitness elements contributed largely to achievement of each ADL. Since significant high correlation was found between the index using 12 ADL items and that using 15 items, it is considered that the 12 items scale can account for the variance corresponded enough to that of 15 items scale, and that the new index is practical and simple.
In further research, it will be required to examine validity of each ADL item and index by using more large sample, and to clarify the relation to various factors influenced to ADL ability level.

The purposes of this study were to examine reliability and validity of ADL index for older people at home, and relationships between ADL score and various factors (ex. self-assessment of health status and physical fitness level, and exercise frequency/week), and to examine the screening basis for execution of physical fitness test based on distribution of ADL score. A questionnaire consisting of 12 ADL items and a physical fitness test of Ministry of Education, Science and Clture were administered to 5, 715 subjects 65 years or more age (male: 2, 745; female: 2, 970) . As a result of examining test-retest reliability of the ADL index, significant high correlations were shown among 12 ADL items (0.674≤r≤0.886), and in overall score (r=0.943) . The ADL score was significantly related to age and physical fitness test scores, and tended to be higher in subjects with a higher self-assessment of health status and physical fitness level, and with more frequency. It was suggested that these results prove the utility of the present ADL index. Further, as the result of examining relationships between distribution of overall ADL score and physical fitness test scores, the following screening bases were considered to be valid for judgement whether the physical fitness tests could be executed. The three screening bases using overall ADL score were: 1) 12 or under; 2) over 13 to under 24; 3) 24 and over. The four bases using item score were: 1) a category 1 response for items 1, 5 and 6; 2) a category 2 or 3 response for items 1, 5 and 6, and a category 1 response for items 3 and 4; 3) a category 3 response for items 2 and 14; 4) a category 1 response for items 10 and 12.